MEDICARE: SIMAR SINGH CHAWLA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207RS0012X	Sleep Medicine (Internal Medicine) Physician	036.170458	IL

General Provider Information

NPI Number	:	1619554318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIMAR SINGH CHAWLA

Provider Business Mailing Address
First Line	:	2242 W HARRISON ST STE 104
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3515
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2242 W HARRISON ST STE 104
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3515
Country	:	US
Telephone Number	:	877-766-6984
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2021
Last Update Date	:	06/24/2025

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